Concussion Rehabilitation That Supports Your Recovery & Safe Return To Sport/Activity

What is a concussion?

A concussion is a mild traumatic brain injury that affects how your brain functions.  It occurs when there is a rapid acceleration/deceleration of the brain inside of the skull - basically imagine the brain briefly bouncing off the walls of the inside of the skull (twisting/shaking briefly).  This acceleration/deceleration force to the brain can be caused by things like a direct blow to the head, a blow to somewhere else in the body where the force of that blow is transmitted to the head/brain.  So it doesn’t just happen from something hitting your head, but can occur from so many other things too like whiplash injuries or falls for example. 

What happens in your brain during a concussion?

When that acceleration/deceleration force on the brain cause it to bounce in the skull, the neurons (nerve cells) of the brain undergo stretching/shearing.  This causes a complex neurometabolic cascade that includes many things that occur at a microscopic/cellular level.  Because this is all occurring at a cellular level, it is not visible on a standard MRI - therefore you can expect that when being diagnosed with a concussion - your MRI will likely be normal.

  During the neurometabolic cascade, damage to the nerve cells lead to an abnormal flow of ions in/out of the neuron and impaired metabolic processes.  This abnormal flow of ions in/out of the neurons causes the neurons to activate, leading to the activation of other neurons however this is all occurring in a completely disorganized and abnormal way.  This ultimately causes impaired neurological communication.  The brain works hard to try to restore a normal neuron ion balance to stop the impaired neurological communication, and to do so it demands more energy however because of the neuronal injury, the brain is unable to produce that energy - therefore there is a metabolic energy crisis.  A decreased blood flow to and through the brain during concussion as well as inflammatory consequences also contribute to this energy crises and impaired neurological communication.  

What are some signs/symptoms of a concussion?

Because the changes occurring in the brain during a concussion are so complex, there are a variety of different signs and symptoms of a concussion.  Here is a list of some of the more common things we may see after sustaining a concussion: 

Physical:

• dizziness

• balance problems

• nausea and/or vomitting

• headache

• neck pain

• sensitivity to light

• sensitivity to noise

• vision issues

Emotional:

• irritability

• depression

• anxiety

• mood swings

• exaggerated emotions

• dazed look

Cognitive:

• feeling slowed down

• difficulty concentrating

• memory issues

• disorientation

• confusion or having a difficult time thinking clearly

• word finding issues

Sleep:

• sleep disturbances (sleeping less or more than normal)

*** only a small percentage of people who sustain a concussion also have a loss of consciousness.  Most people actually do not have a loss of consciousness and it is important to note that a loss of consciousness is not something that diagnoses a concussion. 

How can physical therapy help?  What might concussion rehabilitation look like?

Again, because concussion is complex and can lead to a myriad of symptoms, physical therapy and treatment very much depends on the way in which physical therapy is impacting a person.  

A comprehensive evaluation is one that appropriate assesses what is contributing to or causing symptoms.  There are different clinical trajectories/profiles/subtypes that are helpful to consider and categorize a client in to, in order to help guide treatment.  

Depending on the symptoms/presentation, here are examples of what physical therapy treatment may incorporate: 

• Neck care (exercise to address strength/ROM/proprioception and manual therapy for example)

• Vestibular physical therapy (might include gaze stability, habituation, balance exercises, repositioning maneuvers when indicated. ** 10-30% of people with concussion end up also having BPPV)

• Guided progressive subsymptom threshold exercise and education to address exercise intolerance or dysautonomia

• Vision / Ocular-motor rehab

• Migraine / headache rehab

• Anxiety/mood and/or sleep hygiene (education and assist in management)

Throughout physical therapy evaluation and treatment, we are constantly educating you.  Educating you in what is happening, how your concussion seems to be affecting you and why, and ways to best support your body holistically with things like lifestyle modifications for a solid foundation for recovery.  There are certainly other things that you can do to speed up your recovery, ensure safe return to activity, and decrease your likelihood of experiencing prolonged post concussion symptoms - and you better believe we will be talking about those things as well.  

Soapbox Comment:

Concussions are a mild traumatic brain injury.  I said that already but - this is the brain we are talking about.  There is no such thing as a mild concussion or even a severe concussion.  They should all be taken very seriously.